Sunday, September 18, 2011

Karma: A bitch (by Skylanda)

You never want to point fingers and say I told you so when someone up and dies all young and tragic-like on you. But then, every once in a while, ya know, you do.

The spectacle of Ron Paul’s performance at last week’s GOP debate was chilling, to say the least. To Wolf Blitzer’s questioning, Paul implied that an uninsured 30 year-old man without insurance should be let to die rather than rely on any kind of public funding for his care (nevermind that all insurance relies on collective funding, whether by government or for-profit institutions). Blitzer cornered Paul on this answer, who hedged, bobbled, yammered about friends, neighbors, churches taking over. Meanwhile, the audience roared their approval of when Blitzer asked, “Are you saying that society should just let him die? (The little-spoken but eminently more ridiculous part of the question was that Blitzer’s scenario included the hypothetical 30 year old’s option to get health insurance for $200-300 per month – a truly false offering that blunted the force of Paul’s response by implying that cheap, easy-to-obtain health insurance is somehow a norm.)

A week goes by, and someone did a little homework and trotted out a formerly under-publicized fact: in 2008, one of Paul’s staffers was hospitalized with pneumonia. The staffer – Kent Snyder was his name – was uninsured, and apparently uninsurable; an undisclosed pre-existing condition precluded his ability to obtain covered. He died. His mother inherited the bill - a whomping $400,000. She couldn’t pay it, and the word went out to friends and family to help out, just the way Paul says it happened in the good old days: apparently, you’re now on the hook not only for your own bills, but you should also kick down every time a friend gets sick. Needless to say, generosity only goes so far (especially if the benefactor is deceased and funds are going to pay post-mortem debts); best guess says less than 10% of the bill was eventually paid through these fundraising efforts.

Trotting out this ironic moment was, I believe, supposed to be a play on the sympathies of Americans: the insurance crisis is so large that even the libertarians are not immune. Unfortunately, this Kent Snyder guy is probably the only person in the history of the American health insurance clusterfuck that I do not have great sympathy for. Because he was the instrument of Ron Paul’s rise, and if his overblown obit is to be believed, one of the prime movers behind one of the libertarian ilk’s most enduring caricatures. He reaped what he sowed in spades, and in fact, he reaped what he was trying to heap on the rest of us. He was a firm believer in the libertarian way – including the belief that heath coverage is due only those who can obtain it on the open market – and was credited with Ron Paul’s meteoric return from obscurity in 2008.

Tea party rhetoric to the contrary, folks in my profession answer to a different set of standards than to cheer at the thought of the uninsured man dying from a treatable disease and leaving his family and friends to go bankrupt with the bill. We answer, for one, to our own consciences and morals; and while doctors are a popular whipping boy in the health care reform debate, most of us did not go into the profession to sanctimoniously withhold care based on the color of your insurance card – we went into the profession to ply our trade, and that’s what we do. But we also are bound by a legal mandate, a law called EMTALA.

EMTALA is the anti-dumping law that was passed in the 1980s in response to practice of emergency rooms turning out critically ill but uninsured patients onto the street. Under EMTALA, unless a patient is lucid enough to say they refuse any further care, hospitals are obligated to continue to treat an acutely or critically ill patient (or find a facility that will) regardless of who will pay or who will not pay the final bill. (Honestly, I have seen many direly ill people try to walk out of the ER out of terror of the bill they know they will receive, but I have yet to see a single one gallantly refuse care out of high-horse anti-government welfare mores.) EMTALA is the secret socialist of the American health care system: everyone is guaranteed access through this back-door channel, and once you go bankrupt someone will foot the bill for you. It’s our very American way of making sure that universal access exists, but in the most inefficient, ineffectual, and painful way possible. EMTALA is what let Kent Snyder in the front door of the hospital when he fell ill and let him run up a $400,000 bill he would never pay. EMTALA is essentially unpaid socialized medicine – the public dole without the cash behind the mandate, paid generously by hospitals biting the non-payer bullet, providers providing unvolunteered charity hours, tax collection structures eating the loss at income that was never garnered on patients who never pay half-million dollar bills they ran up. Welcome to universal coverage, American-style.

The real irony of Kent Snyder’s death, of course, is not that sometimes people fall on the sword of their own idiotic making. The irony is that public funds will likely pick up the slack for the $400,000 in services that were generously afforded to him on his way out the door. Because nurses, janitors, lab techs, orderlies, scrub techs, and doctors don’t work for free even for the self-appointed bloody fool nobility known as the American white libertarian male, someone gets to pay that nearly half-million dollar bill, and it will likely look like this: his momma; his friends and family solicited over the website set up for this purpose; the hospital in the form of yet another loss to a non-payer patient; the local, state, and federal tax structures that will take a hit from the income loss they couldn’t tax on yet another non-paying patient.

That’s right, Mr. Snyder: you might have lived your ideals, but you died on the dole. And I’d really like to see Ron Paul and his ilk (and every GOP candidate who stood silently by without a word of objection to this exchange) taken to the table for that inevitable fact.

Cross-posted from my recently re-located and re-launched blog, America, Love it or Heal It.